Smile Train

• In pursuit of happy faces since 2015
• More 3000 happy patients

Smile train is an international organization that is active in more than 90 countries and has helped in funding 15,00,000 surgeries across the globe since 1999. This organization provides free treatment to children born with a congenital deformity of the face called cleft lip and palate.

Clefts are birth abnormalities that occur due to malformation of the lip & palate during pregnancy. It is a very common birth defect that occurs globally in 1 in every 700 neonates that are born. There is a predisposition of Cleft Lip in males with or without Cleft Palate & a predisposition for females in the case of Isolated Cleft Palate. Cleft lip & palate are mostly openings or splits in the lip & palate region due to incomplete closure during pregnancy. It can occur both as an isolated defect or associated with any syndrome.

It is required that these anomalies are treated on time to minimize their impact on the growth, development & function of the child. These surgeries aim to help children accomplish their full capabilities without being defined because of their facial deformities or dissimilarities.

Any abnormality in this area affects how the child speaks, hears, chews, swallows, and how their brain develops.

Through reconstructive surgery, children born with clefts can be transformed. Having partnered with SMILE TRAIN we are working towards this transformation by providing well-equipped medical services to these families. It is a free cleft care program aiming toward the productive life of these affected CHILDREN.

A multidisciplinary team is required for the optimal management of such cases. Our Plastic Surgery department at Vivekanand Polyclinic &IMS, Lucknow is fully equipped with surgical as well as post-surgical management of these children. We have a team of experts for complete physical & emotional childcare led by the Department of Plastic, Craniofacial & Microvascular Surgery integrated with the departments of Anaesthesiology, Paediatrics, Speech Therapy, Orthodontics , and Ear/Nose/Throat.

At the Vivekananda Polyclinic & Institute of Medical Sciences, Dr. Amit Agarwal has been heading the department since 2015, as the Project Director, of Smile Train. Under Dr. Amit Agarwal around 3000 Orofacial Cleft patients have been treated to date. Through this Smile Train Project, Dr. Amit Agarwal and his team have been able to provide free treatment to all these Orofacial Cleft patients.

The specific cause is unknown, but it is mostly multifactorial.

• Genetic predisposition.
• Environmental or Nutritional Factors.

• Family History of Orofacial Clefts.
• Exposure to toxic medicines, alcohol, or drugs during pregnancy.
• Diabetes.
• Obesity.

• Social isolation.
• Risk of severe malnutrition.
• Difficulty in feeding & breathing.
• Speech defects.
• Chronic Ear Infections.

• Prenatal Ultrasound – By the 13th week of pregnancy, Cleft Lip may be diagnosed using Prenatal Ultrasound. However, an isolated Cleft Palate is difficult to diagnose prenatally.
• Amniocentesis – This fluid test indicates the presence of inherited genetic syndrome which may give rise to other birth defects.

• Genetic Counselling – This can help parents to be mentally prepared to face further challenges in their child. The genetic counselor can also help determine the risk.
• Prenatal Tests – This helps to determine the condition of the fetus.
• Avoid Alcohol and tobacco Consumption – These substances have a teratogenic effect on the fetus if consumed during pregnancy.
• Consumption of Prenatal Vitamins – Prenatal vitamins are essential to meet the increased nutrient requirements of the body during pregnancy.

• Reconstruction of damaged bone & tissues to restore their normal functions.
• Improves physical appearance making the patient more socially acceptable & building up the patient’s self-confidence.

Cleft Lip/Palate occurs during the early stages of pregnancy, due to unfused tissues forming a gap involving the lip, palate, alveolus, or nose on single or both sides of the face. The treatment required depends on the involved area and its severity. Multiple surgical procedures may also be required in such patients.

• Done at the age of 3-5 months of the child.
• The child should weigh a minimum of 5 kgs before surgery.
• Through incisions made on both sides of the cleft, flaps are created with the tissue which is then used to suture & close the slit or the opening present in the lip defect.
• The lip muscles are also sutured in the same way. The skin is closed with absorbable sutures.

• Done at the age of 9-10 months of the child.
• The roof of the mouth which includes the hard as well as the soft palate is rebuilt using a specific Palatoplasty procedure.
• The muscle attachment of the palate is corrected in this procedure.
• It is a very important surgery and should be done at the correct time because delay in this procedure may also affect the speech of the patient. Delayed repairs beyond 2-3 years can lead to speech defects in the child.

• This surgery is done in children who have undergone Cleft Palate surgery and are facing speech difficulties with their growth.
• In these patients, Nasoendoscopy is performed to check the closure of the velopharyngeal region at the back of their throat while the patient is speaking.
• In case of an insufficient closure, this surgery is advised.
• This helps to improve the speech of the patient to a great extent followed by regular speech therapy sessions.

• This is a cosmetic correction done for the improved aesthetic appearance of the nose.
• Since the nose plays a very important part in the facial aesthetic, it affects an individual’s entire appearance and his/her personality greatly.
• In children with cleft, Nose deformity is present in almost 80 to 90% of the cases which leads to low self-esteem and confidence in such children.
• Cleft rhinoplasty is quite a very challenging surgery and is usually done at the age of 13 to 15 years in girls and 14 to 16 years in boys.
• The nose is given proper shape through the manipulation of cartilage and graft insertions as it helps uplift the nasal bridge and tip giving it a proper shape.
• It is a very technique-sensitive procedure to be performed by an expert surgeon. Dr. Amit Agarwal has performed more than 100 cleft rhinoplasty with good to decent results.

• This is a corrective jaw surgery, which includes repositioning the upper or lower jaw for the aesthetic improvement of the facial profile.
• This surgery is an advanced procedure that is done after the growth spurt is complete in both boys and girls.
• This is a specialized cosmetic correction performed by Dr. Amit Agarwal.
• The Upper & Lower Jaw are repositioned according to the facial aesthetics keeping the dental occlusion in mind.
• This procedure may require orthodontic treatment before or after the surgery is performed for minor further corrections.

• Le Fort Osteotomy for upper jaw advancement- most commonly done
• Bilateral Sagittal Split Osteotomy for lower jaw setback
• Bi-Jaw Surgery for both the jaws.
• Genioplasty/ chin surgery for chin advancement.

• There are a lot of things that can go wrong at any stage of surgery while operating on a Cleft child. We at Vivekananda Polyclinic &IMS, have an excellent team of anesthetists, pediatricians, and intensivists to take care of the children.
• Bleeding.
• Infection.
• Poor Healing.
• Widening or elevation of scars.
• Temporary or permanent damage to nerves, blood vessels, or other structures.

Dr. Amit Agarwal performs all his Smile train surgeries at Vivekananda Polyclinic and Institute of Medical Sciences, Nirala Nagar, Lucknow. He can be contacted there in room number 5 and 7 on all weekdays between 9 AM to 2 PM daily.